Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options

Robert G. Hart, Kathleen I. Lock-Wood, Antoine M. Hakim, Richard Koller, John G. Davenport, Bruce M. Coull, Robin Brey, Anthony J. Furlan, Bernard J. O'neill, L. Creed Pettigrew, Avindra Nath, Frank M. Yatsu, David G. Sherman, J. Donald Easton, Vincent T. Miller

Research output: Contribution to journalArticle

Abstract

The clinical implications of hemorrhagic transformation of embolic brain infarction were explored by studying 30 patients with cardiogenic brain embolism and either hemorrhagic infarct (HI) or intracerebral hematoma (ICH) on CT. At the time of identification of hemorrhage, 19 patients were receiving anticoagulants and 11 were not. Eight anticoagulated patients and three nonanticoagulated patients developed late HI without attendant worsening after an initial CT was non hemorrhagic. Hemorrhagic transformation without worsening most often occurred after 12 hours but before 48 hours following stroke onset and was associated with large infarcts (82%) but not with age, blood pressure or embolic source. Seven anticoagulated patients, six with large infarcts, and one nonanticoagulated patient with a small infarct abruptly worsened from eight hours to 11 days after stroke, with CT revealing ICH or severe HI. Excessive anticoagulation or acute hypertension potentially contributed to hemorrhagic transformation in four of five patients who were receiving heparin. Brain hemorrhage in embolic strokes most often occurs with large infarcts. Early CT may not allow the identification of large embolic infarcts that are destined to later undergo spontaneous hemorrhagic transformation. For large embolic infarcts, a delay of several days before anticoagulation and special efforts to avoid excessive anticoagulation and hypertension may be prudent. The initial administration of large, bolus doses of heparin should perhaps be avoided.

Original languageEnglish (US)
Pages (from-to)779-789
Number of pages11
JournalStroke
Volume15
Issue number5
StatePublished - 1984
Externally publishedYes

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Intracranial Hemorrhages
Stroke
Hematoma
Heparin
Hypertension
Brain Infarction
Intracranial Embolism
Anticoagulants
Hemorrhage
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Neuroscience(all)

Cite this

Hart, R. G., Lock-Wood, K. I., Hakim, A. M., Koller, R., Davenport, J. G., Coull, B. M., ... Miller, V. T. (1984). Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options. Stroke, 15(5), 779-789.

Immediate anticoagulation of embolic stroke : Brain hemorrhage and management options. / Hart, Robert G.; Lock-Wood, Kathleen I.; Hakim, Antoine M.; Koller, Richard; Davenport, John G.; Coull, Bruce M.; Brey, Robin; Furlan, Anthony J.; O'neill, Bernard J.; Pettigrew, L. Creed; Nath, Avindra; Yatsu, Frank M.; Sherman, David G.; Easton, J. Donald; Miller, Vincent T.

In: Stroke, Vol. 15, No. 5, 1984, p. 779-789.

Research output: Contribution to journalArticle

Hart, RG, Lock-Wood, KI, Hakim, AM, Koller, R, Davenport, JG, Coull, BM, Brey, R, Furlan, AJ, O'neill, BJ, Pettigrew, LC, Nath, A, Yatsu, FM, Sherman, DG, Easton, JD & Miller, VT 1984, 'Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options', Stroke, vol. 15, no. 5, pp. 779-789.
Hart RG, Lock-Wood KI, Hakim AM, Koller R, Davenport JG, Coull BM et al. Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options. Stroke. 1984;15(5):779-789.
Hart, Robert G. ; Lock-Wood, Kathleen I. ; Hakim, Antoine M. ; Koller, Richard ; Davenport, John G. ; Coull, Bruce M. ; Brey, Robin ; Furlan, Anthony J. ; O'neill, Bernard J. ; Pettigrew, L. Creed ; Nath, Avindra ; Yatsu, Frank M. ; Sherman, David G. ; Easton, J. Donald ; Miller, Vincent T. / Immediate anticoagulation of embolic stroke : Brain hemorrhage and management options. In: Stroke. 1984 ; Vol. 15, No. 5. pp. 779-789.
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